The hip joint is surrounded by a fibrous capsule and stabilized by ligaments, muscles and tendons. The capsule can sometimes be weak or lose its shape leading to instability or a tendency for the bones to come out of the joint. Instability may also be caused by damage to ligaments that attach to the capsule. Capsule plication is a procedure to reshape or tighten the capsule to prevent instability.
Hip instability may occur due to excessive loading or rotation of the hip. An unstable hip tends to give out when it is extended or externally rotated during activities. Groin pain is usually also present.
Your doctor will perform a thorough evaluation of your hip to look for signs of instability. Imaging studies such as an MRI may be performed to visualize the joint structures.
Capsular plication is performed through an arthroscopic procedure. You will lie supine with the knee slightly flexed and internally rotated. Small incisions are made over the hip and portals are created to access the joint. Instruments are passed through the portals to visualize and operate on the joint. The capsule is first incised so that the inside of the joint may be visualized. The labrum and surrounding structures are carefully evaluated to identify the cause for instability. There may be overgrowth, thinning, weakening, laxity or tearing of tissues. Any damaged structures are repaired. A suturing device is then passed through a portal to place sutures on the capsule so that its surface folds or overlaps and is shifted downwards. This tightens the capsule and reorients the surrounding capsular fibers to improve the stability of the joint.